Clinical evaluation of the use of laryngeal tube verses laryngeal mask airway for out-of-hospital cardiac arrest by paramedics in Singapore

Jing Jing Chan, Zi Xin Goh, Zhi Xiong Koh, Janice Jie Er Soo, Jes Fergus, Yih Yng Ng, John Carson Allen Jr, Marcus Eng Hock Ong

Singapore Med J. 2020 Aug 17. doi: 10.11622/smedj.2020119. Online ahead of print.

Introduction: It is unclear which advanced airway device has better placement success and fewer adverse events in out-of-hospital cardiac arrests (OHCAs). This study aimed to evaluate the efficacy of the VBM laryngeal tube (LT) against the laryngeal mask airway (LMA) in OHCAs managed by emergency ambulances in Singapore.

Methods: This was a real-world, prospective, cluster-randomised crossover study. All OHCA patients above 13 years old who were suitable for resuscitation were randomised to receive either LT or LMA. The primary outcome was placement success. Per-protocol analysis was performed and association between outcomes and airway device group was compared using multivariate binomial logistic regression analysis.

Results: Of 965 patients with OHCAs from March 2016 to January 2018, 905 met the inclusion criteria, of which 502 (55.5%) were randomised to receive LT while 403 (44.5%) were randomised to receive LMA. Only 174 patients in the LT group actually received the device due to noncompliance. Placement success for LT was lower than for LMA (adjusted odds ratio [OR] 0.52, 95% confidence interval [CI] 0.31-0.90). Complications were more likely when using LT (OR 2.82,0 95% CI 1.64-4.86). Adjusted OR for prehospital return of spontaneous circulation (ROSC) was similar in both groups. A modified intention-to-treat analysis showed similar outcomes to the per-protocol analysis between the groups.

Conclusion: LT was associated with poorer placement success and higher complication rates than LMA. The likelihood of prehospital ROSC was similar between the two groups. Familiarity bias and a low compliance rate to the LT were the main limitations of this study.